Central Serous Chorioretinopathy/Central Serous Retinopathy
Central Serous Chorioretinopathy (CSC or CSR – short for Central Serous Retinopathy) occurs in young adults who complain of central blurring of vision. At the early stage, there is a small area of leakage of fluid (or water bubble) underneath the retina at the macula region. In late stages, there can be large amounts of fluid beneath the retina that may damage the retina and lead to vision loss that cannot be reversed.
Who is at risk of Central Serous Chorioretinopathy or Central Serous Retinopathy?
Central Serous Chorioretinopathy is more common in men than in women, although the exact reasons for this are unknown. Though it can occur in adults of all ages, young and middle-aged adults are form the largest age group for Central Serous Chorioretinopathy patients.
What are the symptoms of Central Serous Chorioretinopathy or Central Serous Retinopathy?
The most common symptom a patient will experience and describe is poor vision acuity, or blurred vision, usually in one eye. Although upon close inspection by a good eye specialist, blurred vision may be observed in the other eye to some degree as well. Vision loss, especially if the serous pocket is situated well within the macula, is sometimes described as well. Loss of vision due to Central Serous Chorioretinopathy is usually reversible in the early stages.
At later stages, patients may experience loss of central vision. Depending on the damage that was already done by the fluid leakage, the retina may be unable recover from the damage sustained and the loss of vision can be permanent.
The severity of symptoms will depend entirely on the location at which the fluid accumulates within the eye and under the retina. When the serous detachment is at the edge or outside the macula, symptoms may not be as apparent to the patient. This is because the macula is the part of the retina used in recognition of finer details, such as when during reading, or having to distinguish between similar objects. Serous detachments and fluid leakage that develop outside of the macula may go undetected for extended periods of time, and may have done more damage to important parts of the eye or retina such as the retinal pigment epithelium – where damage may result in atrophy of the photoreceptor cells in the retina.
What are the caues of Central Serous Chorioretinopathy/Central Serous Retinopathy?
Causes of Central Serous Retinopathy are not clearly understood, although there are certain risk factors identified that contribute to the likelihood of developing this condition.
Risk factors for CSR are:
- High Stress Lifestyle
- Type A personality
- Usage of steroid medication and other hyperdynamic circulatory drugs.
- Pregnancy/Recently Pregnant
- Usage of other drugs such as stimulants/decongestants
It is believed that usage of corticosteroid medication may also possibly lead to developing or worsening Central Serous Chorioretinopathy. These steroids are commonly found in nose sprays used for managing allergy symptoms and anti-inflammatory external use creams for skin. These drugs, depending on the region you live in, can be readily available over-the-counter. In Singapore, there are a number of over-the-counter products that can be purchased without a prescription from a medical practitioner.
A link has been found between Central Serous Retinopathy and persons with a “Type A” personality and/or persons undergoing emotional duress as a risk factor. It is believed that the body possibly produces substances that act like corticosteroids during times of stress, and may contribute or set off the development of Central Serous Chorioretinopathy in a person that is already susceptible or prone to it.
When investigated, roughly about half the patients suffering from Central Serous Chorioretinopathy have at least one relative with traces of this condition upon examination. This leads us to believe that genes may play a role in the susceptibility of a person to this condition. However no specific inheritance patterns have been found or identified thus far.
What tests are used in diagnosis of Central Serous Chorioretinopathy?
The first and probably most important test is a complete and detailed eye examination of both the eyes by an eye specialist. The eyes will be dilated during this examination, and if required, images will be captured to document the existence and current condition of the patient.
Other tests such as an OCT – short for Optical Coherence Tomography, which allows the eye specialist to study the retina at a microscopic level are useful for diagnosis. This allows the eye specialists to identify minute pockets of leaked fluid or places where it has happened before.
Fluorescein angiography may also be used to capture images of both eyes. The test involves having dye injected into the patient’s bloodstream, and help the eye specialist detect the pockets of fluid as the dye collects in them.
These tests will allow the eye specialist to fully distinguish between Central Serous Chorioretinopathy and all the other possible conditions that may cause fluid to collect in the eye, or at the retina.
Treatment for Central Serous Chorioretinopathy
In the past, it was thought that CSR could resolve on its own within 6 months so treatment was delayed while waiting for self-resolution. We know now that treatment is best done early before any inadvertent retinal damage ensues. Treatment options include medication and different types of laser depending on the severity.
Patients that have been diagnosed will be advised to stop usage of any steroids. In the case that you are required to as part of another prescription, or are unsure of the nature of the product, feel free to consult your eye specialist and the prescribing medical practitioner on what can be done in this situation. Sudden discontinuation of steroids at high doses can be dangerous, always seek medical advice on the proper course of action when it comes to steroids.
Photodynamic therapy (PDT) is one of the laser treatment options available. A photosensitive drug is administered via a vein injection, and then activated by using a special cold laser at the areas affected by Central Serous Chorioretinopathy. This treatment is effective in stopping the leakage of fluids at the sites in the retina/macula.
At Asia Retina, we recognise that every case of Central Serous Chorioretinopathy can be similar in many ways. yet different for each individual. Still, early detection of Central Serous Chorioretinopathy is very helpful in preventing further vision loss and aiding in risk factor management. Permanent vision loss can also be avoided when Central Serous Chorioretinopathy is detected early enough.
Why Asia Retina Eye Surgery Centre
At Asia Retina, we are able to provide non-damaging laser treatment in the early stage of CSR to avoid permanent vision loss and achieve better visual outcomes for our patients.